Electronic medical records (EMR) are in the news almost every day as a key component of the Affordable Care Act, and as health care organizations across the country scramble to meet a 2015 deadline to implement EMRs in order to avoid Medicare penalties and access reimbursement incentives. HHC will soon begin to implement a new state-of-the-art EMR to replace the current system, which is nearly 20 years old, and achieve greater capacity to advance quality initiatives, care coordination, and efficiency. The new EMR will be in full operation by 2017 for HHC's 22,000 users. Bert Robles, HHC Senior Vice President and Corporate Chief Information Officer, discusses some of the highlights of the new EMR system.

Why does HHC need a new EMR?

In the early 1990s HHC became one of the earliest adopters of EMR technology. Over the years, the IT team worked to improve that system and enhanced it with features such as embedded depression screening aids, asthma action plans, and guidelines to treat deep-vein thrombosis. But today's modern EMRs outperform what we have in place. The new system will offer robust decision support functionality, better data integration and interoperability, and greater capacity to advance our quality initiatives. Modern EMRs can provide clinical alerts and reminders, improve diagnostic and therapeutic choices, enhance research, and monitor for improvements in clinical quality, all while providing built-in safeguards against adverse events. This will be an important step for HHC both in efficiency and improving patient outcomes.

Will the new EMR be universal across every HHC patient care area?

Yes. The new EMR will provide one integrated patient record across all HHC hospitals, long-term care facilities, diagnostic and treatment centers, and community based clinics. It will extend and standardize EMR functionality to behavioral health, anesthesia, all ORs, and all emergency departments. Records created at one facility will be easily accessible at another. Staff training will be condensed to just one EMR system. Over 8,000 physicians, 2,500 residents, 9,000 nurses, and many others will use the system on a daily basis.

Will patients notice a difference with the new system?

We hope they do. The new system offers many benefits to patients and will allow us to improve communications between providers and patients. For example, the new EMR will offer patients the ability to view their medical records in a secure environment from anywhere on the web. It will also make it easier for patients to transfer medical records to another health care provider or to a health information exchange. Our patients will have the opportunity to be further engaged in their care in a comprehensive manner across all venues.

Can HHC afford a new EMR?

A new EMR for an organization as large as HHC is expensive, but so is maintaining and improving the old EMR. When considering all the factors that affect cost, the total cost of ownership of the new EMR is not much more than keeping the existing system. A new EMR will mean that HHC will be able to retire over 90 applications built to support the current system. Much of the cost will be offset by federal funding made available to organizations that can demonstrate "meaningful use" of EMR systems. HHC has already received $60 million for demonstrating Stage 1 meaningful use, and we will receive more for achieving higher levels. And of course we will have a much better system that will help us deliver care more efficiently using the latest technology.

How will you implement the new system? Do you just turn off the old and turn on the new?

I wish it were that simple. Rolling out a new EMR in an organization as large as HHC is a huge task. We have to purchase and customize hardware and software. Then we will go about receiving large scale input from the user community within HHC, making them intimately involved in designing our model of implementation. That will involve work sessions with people in a variety of roles representing every facility. We already have over 200 of those work sessions scheduled for July and August. One facility will eventually be selected as the first pilot location to go live with the Epic system. The rest of the organization will go live over the next three to five years, facility by facility. And of course there will be a substantial amount of training involved for the user community both remotely and in classroom settings.

When can we expect the new system to be completely ready for use?

It will take several years. Remember, it all has to take place while the current EMR system continues to be used, with a seamless transition to the new system when the time comes. The new system should be in full operation by 2017.